La inclusión del concepto en los instrumentos internacionales que regulan la protección de datos

Why is it that all men who are outstanding in philosophy or politics or poetry or the arts are melancholic, and some to such an extent that they are infected by the diseases arising from black bile, as the story of Heracles among the heroes tells?

—Aristotle, Problem XXX.1

T

hroughout his “notes,” Nikolai Stepanovich, the renowned professor of physiology and fictional author of Anton Chekhov’s novella “A Boring Story,” describes the symptoms and signs of a disease that he believes will kill him within half a year. Psychological symptoms figure prominently in his self-examination. He complains that since the onset of his illness he has undergone a change in his personality, his moods, and his “worldview”

(mirovozzrenie). It is his search for the origins of a new and uncharacteristic pessimism that initiates the crisis of identity around which the plot of the novella is largely structured. In a conversation with his adopted daughter Katia, Nikolai Stepanovich describes how his life has changed before asking a series of probing questions:

day and night evil thoughts fester in my head, and feelings I’ve never known before have built a nest in my soul. I hate, I despise,

I’m indignant, I’m exasperated, and I’m afraid. I’ve become excessively strict, demanding, irritable, unobliging, and suspicious.

Even things that would have once given me occasion to make an unnecessary pun and laugh amiably now only produce a sense of weariness in me. My sense of logic has also changed. . . .

What does this mean? If these new thoughts and new feelings have arisen from a change in my convictions, then where could this change have come from? Has the world really grown worse, and me better, or was I just blind and indifferent before? If this change has arisen from a general decline in my physical and mental powers—

I’m sick, after all, I’m losing weight every day—then my situation is pitiful; it means that my new thoughts are abnormal, morbid, that I should be ashamed of them and consider them worthless.¹

In this passage and elsewhere in the novella, several possible reasons for the change in Nikolai Stepanovich’s view of life are evoked: illness, the world around him, new insight. Of particular importance for an understanding of the professor’s crisis is that he establishes a mutually exclusive choice between illness and insight in a search for the origin of his pessimism. Either his new thoughts are “abnormal” (nenorml’ny) and “morbid” (nezdorovy) or he has only now ceased to be “blind and indifferent” (slep i navnodushen). Interrupt-ing Nikolai Stepanovich’s speech, Katia repeats this opposition even as she seeks to answer his questions: “Sickness hasn’t got anything to do with it. . . . Your eyes have simply been opened, that’s all.” As a physician treating himself, however, Nikolai Stepanovich seriously weighs the merits of the opposing, psychopathological explanation. If his new pessimistic thoughts are symptoms of his illness, then they must be, as he suggests in another passage, “accidental, fleeting, and not deeply rooted within me.” If these new thoughts are not just symptoms, on the other hand, but the result of a deeper penetration into the general lack of meaning in his life, then “the sixty-two years I’ve lived through must be considered wasted.”²

Literary critics, following the lead of the novella’s two main characters, have weighed in on both sides of this debate. Among those who stress the importance of illness for an understanding of Nikolai Stepanovich’s predica-ment, M. M. Smirnov argues, “it is useless to analyze the judgments of the hero-narrator, because they are only a symptom of his disposition [miroo- shchushenie].”³ Carol A. Flath, in a recent article, defends Nikolai Stepanovich against those critics who would “condemn [his] behavior in the present”: “For all of the professor’s perceptions are colored by his pain and suffering. . . . I would like to suggest [his disease] is primarily physical in the sense that the crisis is provoked by the illness, not the reverse.”⁴ On the opposing side, sev-eral critics have emphasized how penetrating, if not always reliable, Nikolai

Stepanovich’s insights can be. Lev Shestov leans heavily on the “originality”

of the professor’s pessimism in “A Boring Story” to justify his famous claim that Chekhov is the “poet of hopelessness,” and Marina Senderovich consid-ers Nikolai Stepanovich “an existential thinker” who faces his existence “as a vital necessity of his own being.” In a statement that contradicts Smirnov’s and Flath’s views almost point by point, Leonid Gromov writes: “The hero of the novella, having understood the [futility] of his work and not having found the meaning of life, loses the ground under his feet, loses the mark of a ‘living person,’ and senses the approach of death. Precisely in this lies the terrible tragedy of the old scientist—whose life changes into a ‘boring story’—and not in his physical illness.”⁶

What has not yet been undertaken in the critical literature on “A Boring Story,” despite some steps in this direction by Flath and Evgenii Meve, is a thorough examination of the novella’s medical subtext.⁷ Cribbing the cryptic title Nikolai Stepanovich gives to his own romance with his wife, it can be said that the novella depicts, among many other parallel and often loosely connected plot lines, a “Historia morbi.”⁸ Significantly, Nikolai Stepanovich informs neither the reader nor Katia what disease he believes himself to be suffering from. He does not even consult other physicians to confirm his own, unnamed diagnosis. This omission provides the impetus for the present arti-cle. From the few offhand comments he makes concerning the symptoms and signs of his disease, I have attempted not so much to render a scientifically precise diagnosis as to historically reconstruct, by drawing on contemporary medical intertexts, the diagnosis he himself seems to have made.⁹ Nikolai Ste-panovich scatters many symptoms and signs of an unnamed disease through-out “A Boring Story.” If the conceptual leap that he himself makes from these signs and symptoms to his own self-diagnosis entails a movement from the surface of the body to deep organic structures, then an examination of his condition on the part of a literary critic involves a similar movement from the body of the text to an underlying medical subtext. This medical subtext is not directly visible in “A Boring Story,” yet the novella does trace a network of signs that evoke the outline of a specific, contemporary disease concept. Since psychopathology plays an integral role in the novella’s argument, determining the disease from which Nikolai Stepanovich believes himself to be suffering places the implications of his crisis in a new critical light.

At first glance, such a diagnostic undertaking might appear to be of little scholarly interest. A precise diagnosis of Nikolai Stepanovich’s illness would demonstrate what is already a commonplace in Chekhov criticism, namely, that his medical portraiture is rigorously realistic. Conversely, an overreliance on the method of differential diagnosis would superficially resolve the philo-sophical problems that the novella presents.¹⁰ These pitfalls aside, there nev-ertheless remains room for balanced comparative analysis of the intersection

between medicine, poetics, and epistemology in Chekhov’s “A Boring Story.”

As literary critics since Lev Tolstoi have noted, there is in Chekhov’s prose an “impressionistic” quality; or, as Aleksandr Chudakov puts it, an “incidental wholeness.”¹¹ In “A Boring Story,” symptoms and signs are abundant, but the professors own self-diagnosis, which might unite them into a coherent clini-cal picture, is lacking. Instead, these symptoms and signs appear as discon-nected and often incidental details in Nikolai Stepanovich’s broader literary self-portrait. His notes are filled with many other “boring” matters ostensibly unrelated to his medical condition, ranging from his digressions on various topics in contemporary Russian society to his reflections on Katia’s tragic life.

This lack of a unifying diagnosis seems structurally strategic, for the novella not only withholds a disease whose name might have upset the balance be-tween the two main, conflicting interpretations of its protagonist’s crisis—

illness and insight—but this omission also creates a certain affective ambiva-lence. Does not the professor’s propensity for digression, ellipsis, and surface details, as well as his inability to draw on his life experience to say some-thing meaningful to Katia in her despondency, reflect some of the speech patterns of melancholia? In an observation that has wider stylistic relevance for Chekhov’s so often melancholy prose, Nikolai Stepanovich confesses of his thoughts that “I have lost the sense of their organic connection.”¹²

Shifting from literary to clinical portraiture, it is nonetheless possible to provide a reasonably exhaustive list of the symptoms and signs to which Nikolai Stepanovich alludes. At the beginning of the novella, he complains of an “incurable tic” (neizlechimyi tic). This tic appears again in the last sec-tion: “There’s a dull pain in my cheek—the tic has started” (V shcheke tupaia bol’—eto nachinaetsia tic).¹³ He is also suffering from chronic insomnia, which he wryly claims has become the “chief and fundamental feature of my ex-istence” (glavnuiu i osnovnuiu chertu [moego] sushchestvovaniia).¹⁴ Elsewhere he notes that he loses weight daily, that he often feels chilled, and that his head and hands “shake from weakness” (triasutsia ot slabosti).¹⁵ While lectur-ing he experiences an “unconquerable weakness in [his] legs and shoulders”

(nepobedimuiu slabost’ v nogakh i v plechakh), his “mouth becomes dry” (vo rtu sokhnet), his “voice grows hoarse” (golos sipnet), his “head spins” (golova kruzhitsia), and he “incessantly drinks water” (to i delo p’iu vodu).¹⁶ At one point during the novella he faints; at another he wakes during the night in a sweat, tries to take his pulse, and begins to hyperventilate.¹⁷ In a particularly revealing passage, he expresses the hope that he is mistaken “about the albu-min and sugar I find, about my heart, and about the edema I’ve now twice seen in the morning” (naschet belka i sakhara, kotorye nakhozhu u sebia, i naschet serdtsa, i naschet tekh otekov, kotorye uzhe dva raza videl u sebia po utram).¹⁸ Nikolai Stepanovich’s psychological symptoms are more difficult to isolate and categorize than these physical ones. In broad terms, his psychological

symptoms include withdrawal from family and friends, irritability, uncon-trollable sadness and fear, weakness in memory, pessimistic thoughts, and paralyzing indifference, a condition he calls “premature death” (prezhdevre-mennaia smert’).¹⁹

Since the argument of the novella is based upon the very nature of these psychological symptoms, however, any attempt to summarize them is inher-ently problematic. Indeed, the search for a diagnosis of Nikolai Stepanovich’s disease in “A Boring Story,” far from resolving his crisis, opens onto an expanse of further problems, ranging from the reliability of self-analysis in mental disease to the lingering dualism in nineteenth-century materialist psychiatry.

First, as the Russian psychiatrist Sergei Korsakov writes in the introduction to his Course on Psychiatry (1893), a textbook Chekhov owned, “the manifes-tations of mental diseases in separate cases are extremely varied, but what is common to all them is that the ‘personality’ [lichnost’ cheloveka] alters.”²⁰ Yet, as is the case with several of Chekhov’s medically inflected stories and plays,

“A Boring Story” opens after a change in Nikolai Stepanovich’s personality has apparently already taken place.²¹ The reader is directly familiar only with the character of an altered, dying Nikolai Stepanovich. From a purely clinical perspective, his tendency for most of the novella to contrast his dreary present with a happier past might thus be seen as itself symptomatic of a pervasive melancholia. In a related manner, the reader is never able to step outside the shadow cast by Nikolai Stepanovich’s melancholy prose, and thus it remains difficult to gauge the merit of his increasingly self-critical judgments on his own life, which he claims had earlier seemed to be “a beautiful and ably made composition” (krasivoi, talantlivo sdelannoi kompozitsiei) but whose “finale”

( final) he now fears he is spoiling.²²

Second, this question of the reliability of the narrator-protagonist’s self-examination has an epistemological dimension arising from the superimposi-tion of two central dualities in modern medicine; namely, those of mind and body and of physician and patient. Nikolai Stepanovich reveals to the reader his symptoms, which as a patient he experiences directly, as well as the clinical signs that he has gathered as a physician. In his hypochondriacal attention to medical textbooks, however, he seems troubled by more than just the clinical dimensions of his self-diagnosis: “Now, when I diagnose and treat myself, I have the hope every now and then that my ignorance is deceiving me . . . when, with the zeal of a hypochondriac, I reread my textbooks on therapy and daily change my medications, it always seems to me that I’ll come across something comforting.”²³ Nikolai Stepanovich’s hypochondria would seem to result in part from the conflation of roles that arises, not only as his pro-fessional impartiality breaks down during the course of self-treatment, but also as his diseased body begins to infect the thought processes of his medi-cally trained mind. In Chekhov’s realist aesthetic, an aesthetic that is arguably

more phenomenological than materialistic, it is not just the objective fact of a disease that is portrayed, but a character’s subjective experience of illness.²⁴ The physiological processes that govern the progression of his disease acquire meaning inasmuch as Nikolai Stepanovich strives, as a physician, to under-stand their psychopathological consequences. Conversely, and more press-ingly, Nikolai Stepanovich’s “new” and “evil” thoughts—which have provoked a reevaluation of his long and illustrious life—become an existential problem to the extent that he grapples, as a patient, with the question of whether they derive from recent illness or belated insight.²⁵

Nikolai Stepanovich’s role as a renowned physiologist during the rise of materialism in psychiatry further renders the crisis occasioned by his ill-ness all the more acute. As the soul gradually disappeared as an explanatory principle in mental disease throughout the nineteenth century, the human-ist attributes of the soul—the immaterial intellect and free moral agency—

began to lose their epistemological footing. Nikolai Stepanovich’s anxiety about the origin of his pessimism can be interpreted against the background of the tendency in materialist psychiatry to dissolve the mind into physi-ological processes as well as the philosophical and ethical problems that this reduction—which preceded Freud and now, in the “Age of Prozac,” seems to be outliving him—has long engendered. Caught between the options of illness and insight, which had become mutually exclusive in mainstream psy-chiatry by the end of the nineteenth century, Nikolai Stepanovich follows the course of his own spiraling thoughts, which seem to grow more penetrating the more his marasmus advances, yet unearth less meaning from his life the deeper they penetrate.

Diabetes

One of the clinical signs that Nikolai Stepanovich mentions in passing in his notes is glycosuria. Glycosuria, or sugar in the urine, was the definitive sign of diabetes in the second half of the nineteenth century. Yet, as the cel-ebrated French physiologist Claude Bernard suggests in one of his seminal midcentury studies on diabetes, “the existence of sugar in the urine does not constitute diabetes. It is the proportion of this material that is important.”

Indeed, the difficulty in distinguishing between a glycosuria that is “in a certain sense normal” and the glycosuria of diabetes presents a diagnostic dilemma: “the majority of physicians do not render a diagnosis of diabetes until glycosuria becomes permanent.”²⁶ In “A Boring Story,” Nikolai Stepa-novich mentions the sugar he “finds” (nakhozhu), presumably in his urine, using an imperfective verb in the present tense. This would seem to indicate a recurring clinical result, but he does not mention for how long or how many times this sign has presented itself. Moreover, in the same passage, he even compares himself to a hypochondriac, a comparison it would be at least

possible to take at face value. If on the one hand hypochondria (as a subtype of melancholia) was often cited as a concomitant condition of diabetes, then on the other hand, as the British pathologist William Dickinson notes in his 1877 monograph on diabetes, “in acute mania and in melancholia a trace of sugar is the rule rather than the exception.”²⁷ While a diagnosis of hypo-chondriacal melancholia would not necessarily preclude one of diabetes, it is nevertheless typical of the clinical portrait that follows that a single clinical sign evokes both physical and psychological conditions.

In terms of differential diagnosis, however, the evidence in favor of dia-betes is much more substantial than simply glycosuria. A second clinical sign especially indicative of the terminal stages of diabetes, and which Nikolai Stepanovich mentions alongside glycosuria, is albuminuria, or albumin in the urine. Dickinson explains that this “later complication” is often the only visible sign of an underlying “renal change”: “When sugar and albumen are together, the sugar as a rule is primary, the albumen consequent. The kidneys, goaded by the diuretic action of the sugar, after a time show signs of irritation and allow a little albumen to escape as the result of congestion or tubal dis-turbance.”²⁸ The presence of albuminuria suggests that one of the sequelae of Nikolai Stepanovich’s diabetes maybe what was known as “Bright’s disease.”

In the second half of the nineteenth century, Bright’s disease was a common diagnosis that covered a variety of forms of nephritis (inflammation of the kidneys) and that was often noted alongside diabetes. In his 1872 treatise Des terminaisons du diabète sucré, Pierre Costes, for example, describes how in many cases the patient dies as a “result of Bright’s disease, which comes to complicate the preexisting diabetes. . . . The two ailments march in tandem and precipitate the dénouement . . . in such cases it is difficult to determine precisely what should be attributed to Bright’s disease and what to diabetes.”

In terms of diet, furthermore, Nikolai Stepanovich mentions not only that he drinks water “incessantly” (polydipsia), a characteristic symptom of diabe-tes, but also that he suffers from “daily” weight loss (autophagia), indicating that his illness has likely reached an advanced stage. As Costes writes, after the commencement of “the stage of autophagia” further complications arise and “the patient is lost”: “In the midst of diverse impairments, the marasmus particular to the diabetic [le marasme particulier au diabétique] imperceptibly prepares itself.”²⁹

Nikolai Stepanovich’s cardiovascular complications can also be situated in this clinical portrait of diabetes. The edema that he has twice seen (likely in his extremities) further suggests the onset of the serious heart congestion typical of Bright’s disease. Even more ominously, Nikolai Stepanovich seems to suffer from what Flath calls a “panic attack” and Meve “angina pectoris”

(grudnaia zhaba) when he awakes during a “sparrow’s night” (vorob’inaia noch’) in section five.³⁰ As Nikolai Stepanovich writes, “in my body there was

not one sensation that might indicate that the end was near, but my soul was oppressed by horror, as if I had suddenly seen a vast, ominous glow.” Having awakened, the professor becomes immediately concerned with such bodily functions as his breathing and heart rate: “I feel for my pulse and, not finding it in my wrist, search for it in my temples, then under my chin, then again in

not one sensation that might indicate that the end was near, but my soul was oppressed by horror, as if I had suddenly seen a vast, ominous glow.” Having awakened, the professor becomes immediately concerned with such bodily functions as his breathing and heart rate: “I feel for my pulse and, not finding it in my wrist, search for it in my temples, then under my chin, then again in

In document LA FIGURA DEL RESPONSABLE EN EL DERECHO A LA PROTECCIÓN DE DATOS (página 63-80)